Monday, March 16, 2009

Last Monday, Rep. John Hall [D-NY], the chairman of the House Veterans’ Affairs subcommittee on disability assistance and memorial affairs, introduced important legislation that would give vets coping with PTSD easier access to their disability benefits and the treatment they need. Press release:

After visiting with veterans at the U.S. Veterans Hospitals at both Montrose and Castle Point, Congressman Hall announced legislation he has written called the COMBAT PTSD Act: Compensation Owed for Mental Health Based on Activities in Theater. The legislation will remove the onus from any veteran diagnosed with PTSD to have to prove that a specific incident during combat caused his or her PTSD. Hall's COMBAT PTSD Act will make it so that any veteran diagnosed with PTSD who served in combat will automatically have the ability to get treatment and benefits for the service injury of PTSD. ...

The VA's current policy forces veterans to "prove" that a specific stressor during a war triggered their PTSD, even if they have already been diagnosed and been receiving treatment for the condition. Veterans must track down incident reports, buddy statements, present medals, and leap other hurdles to validate to the VA that their PTSD was a result from their war service.

"The current policy violates common sense," stated Hall. "A soldier who does not have PTSD before entering a war, who returns home from war with PTSD, should not have to prove that his PTSD is a result of a specific experience during war. Simply serving in combat can induce PTSD. The wars America is fighting right now have no front or rear lines. Danger can strike in any place, anywhere. It is clear that the current regulations are in need of change."

Under the existing system, the VA Clinician's Guide warns examiners that PTSD symptoms are "relatively easy to fabricate," directing them to supplement treatment records with elaborate documentation from claimants' family and friends concerning changes from pre- to post-service status. Despite the fact that one of the diagnostic criteria for PTSD is an inability to recall important aspects of a trauma, reviewers routinely deny or remand claims due to incomplete information.

As labor-intensive for reviewers as for claimants themselves, this system has yielded a backlog of over 900,000 claims.

At the same time, the VA continues to measure employee productivity by number of cases processed, offering reviewers an incentive to take any shortcut necessary to clear their desks of pending claims. The resulting combination of too much work and too little time ultimately gives rise to premature -- and inaccurate -- determinations, setting in motion years of appeals. ...

According to VA spokeswoman Kerri Childress, eliminating the proof requirement "would be a travesty for veterans -- an assault to the pride of honest soldiers when other vets scammed the system."

Such cynicism, however, hardly seems justified by actual numbers; not only are 50% of rejected claims reversed at the first level of appeal, but 90% of claims that reach the final stage of review are ultimately approved. Far from ensuring the veracity of claims, the proof requirement serves chiefly to postpone the delivery of benefits, often until too late.

It should also be noted that no other disability insurance system, be it the Social Security Administration or the private medical insurance industry, is designed around a presumption of claimant fraud.

Rep. John Hall (D-NY 19th) has introduced H.R. 952; which clarifies the meaning of combat with the enemy for the purposes of service connected disabilities.

Currently section 1154(b) of title 38 states that the Secretary must accept service connection of an injury if it is shown to have occurred while engaged in combat with the enemy regardless if it is officially documented or not. However, what constitutes contact with the enemy is not clearly defined in the current statute.

Rep. Hall’s Bill adds a section at the end of 1154(b) that clearly defines combat with the enemy as being in a theater of combat operations during a period of war, or in combat against hostile forces during a period of hostilities. Essentially, this bill makes contact with the enemy presumptive when claiming injuries for compensation and pension from the VA.

This is one of many corrections that are needed to plug the holes and vague language that permeates the VA disability process.

Sullivan's statement is highly recommend. Worth noting for our discussion here, he came out strongly in favor of the COMBAT PTSD Act in his opening statement:

In February 2008, VA told this Committee it expected to treat about 333,000 Iraq and Afghanistan war veterans in 2009. However, by September 2008, VA had already treated more than 400,000.

Based on the current rate of more than 10,000 first-time patients flooding into VA each month, VA may expect a total of 520,000 Iraq and Afghanistan war veteran patients by September 2009. In contrast, VA Secretary Shinseki testified today that VA expects to treat 419,000 patients in 2010.

VCS recommends five priorities for VA’s 2010 budget.

First, VCS urges Congress to streamline VA’s claims system and quickly pass Chairman John Hall’s “COMBAT PTSD Act,” HR 952. More than 105,000 Iraq and Afghanistan war veterans are diagnosed by VA with PTSD. However, only 42,000 receive disability compensation for PTSD.

In 2008, the Institute of Medicine concluded there is a link between deployment to a war zone and PTSD. With a law or regulation based on science, VA can improve the lives of tens of thousands of disabled veterans during an economic crisis when their needs are most acute.

Soldiers have been required to serve multiple combat tours that sometimes stretch beyond a year, with shorter periods back home. Col. Carl Castro, an Army psychologist and suicide researcher, recently told USA Today that after six- to seven-month deployments in a war zone, troops display more depression, higher PTSD rates, and other mental health issues. "And I think it has to do with the separation from family and friends and that social support network," he said.

Yet the VA health system has a shortage of trained mental health professionals. There are long waits for support services. And the stigma persists. When the idea of awarding the Purple Heart to those with combat-related PTSD came up in May, a maelstrom of criticism ensued, with many saying there is no way to prove the injury, or that it isn't a "real combat wound." PTSD still doesn't qualify.

The staff shortages, the stigma, the stress of long deployments won't be helped by Hall's legislation. But making treatment automatic with a PTSD diagnosis is a huge step. It normalizes the war injury to soldiers, especially those who struggle with admitting they have it. Part of the duty our country owes to those who serve is to return them safe and whole, physically and mentally, to their loved ones.

Attention to this bill is necessary. Consider contacting your elected officials and discussing it with them. There are a lot of priorities on Capitol Hill right now, so it's vital to keep nudging them back to tending to this one, too.

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
As a new generation of warriors returns to civilian life and seeks out resources, PTSD Combat is here to help.

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Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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